Epistles of Le Révérend Docteur

Melancholic depression is characterized by a loss of pleasure (anhedonia) in most or all activities, a failure of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early morning waking, psychomotor retardation, excessive weight loss or excessive guilt.

Anhedonia is often experienced by drug addicts following withdrawal; in particular, stimulants like cocaine and amphetamines cause anhedonia and depression by depleting dopamine and other important neurotransmitters. Very long-term addicts are sometimes said to suffer a permanent physical breakdown of their pleasure pathways, leading to anhedonia on a permanent or semi-permanent basis due to the extended overworking of the neural pleasure pathways during active addiction, particularly as regards to cocaine and methamphetamine. In this circumstance, activities still may be pleasurable, but can never be as pleasurable to people who have experienced the comparatively extreme pleasure of the drug experience. The result is apathy towards healthy routines by the addict.

A mood disorder can be classified as substance-induced if its etiology can be traced to the direct physiologic effects of a psychoactive drug or other chemical substance, or if the development of the mood disorder occurred contemporaneously with substance intoxication or withdrawal. Alternately, an individual may have a mood disorder coexisting with a substance abuse disorder. Substance-induced mood disorders can have features of a manic, hypomanic, mixed, or depressive episode. Most substances can induce a variety of mood disorders.

Oscar Wilde once opined: “I believe that the presence of anhedonia defines depression; if one does not have anhedonia one is simply not depressed.”

Scales designed to assess hedonic responsiveness:

Snaith-Hamilton Pleasure Scale (SHAPS)

Fawcett-Clark Pleasure Capacity Scale (FCPS)

Revised Chapman Physical Anhedonia Scale (CPAS).

Analysis revealed that Hedonic Capacity Factor was largely defined by the SHAPS but also had a substantial loading from the FCPS.

Hedonic Capacity was minimally correlated with constructs of Depression and Anxiety, which were assessed by the Beck Depression Inventory-II and the Beck Anxiety Inventory. The CPAS (anhedonia) was not significantly related to Hedonic Capacity or Anxiety, but it did have a small positive loading on Depression. These findings suggest that further research is needed to clarify the meaning of and relationships among scales that are putative indicators of hedonic capacity and anhedonia. Inc. J. Clin. Psychol.62, 1545-1558, 2006.

The Revised Physical Anhedonia Scale assesses a self-reported deficit in the ability to experience pleasure from typically pleasurable physical stimuli such as food, sex, and settings e.g., “Beautiful scenery has been a great delight to me.”)

The Revised Social Anhedonia Scale assesses deficits in the ability to experience pleasure from non physical stimuli such as other people, talking, exchanging expressions of feelings (e.g., “A car ride is much more enjoyable if someone is with me.”)

The Perceptual Aberration Scale assesses psychotic-like experiences such as bodily discontinuities and unusual scenery experiences (e.g., “I have felt that something outside my body was a part of my body”)

The Magical Ideation Scale assesses erroneous beliefs that are based in magical thinking (e.g., “I have occasionally had the silly feeling that a TV or radio broadcaster knew I was listening to him.”)

The idea of a link between creativity and mental illness goes back to the time of Aristotle, when he wrote that eminent philosophers, politicians, poets and artists all have tendencies toward “melancholia.”